Intestinal resection and multiple abdominal hernia mesh repair : is the combination safe and feasible?

In a highly advanced era from the point of view of instrumental diagnostic resolution it is, however, not always possible to obtain a precise preoperative diagnosis. Surgery is sometimes the only decisive solution. In April 2003, a 62-year-old male patient was referred to us for umbilical hernia, diastasis recti abdominis and left-sided inguinal hernia; he also complained of pain in the mesogastric-hypogastric region. This site presented with a hard, non-mobile, painful tumefaction at both superficial and deep palpation. The patient was submitted to various diagnostic examinations (pancolonoscopy, CT, X-ray of the digestive tract and angiography), but only surgery allowed us to establish the specific nature of the tumefaction. The operation consisted in the en-bloc removal of an abscess mass affecting intestinal loops, caecum and appendix and at the same time in the repair of the hernia components with the use of prosthesis in a potentially contaminated area. The tumefaction had originated following acute appendicitis episodes that had determined adherences between the appendix, caecum and ileal loops (histologically confirmed). There are situations that require surgery in order to be explicitly diagnosed and solved. Furthermore, although the use of prosthetic materials in the treatment of hernias in association with intestinal resection is an extreme case, it has also been reported in the international literature that nowadays there are no real contraindications to the implantation of a prosthesis in a potentially infected area.